Addressing the confusion surrounding dementia

Dementia[1]  currently affects one in three people in the UK over the age of 65, with the number set to inevitably rise as time progresses due to an ever aging population. (1) So more than ever, it is important as a society to be aware of the signs and how we can help sufferers, their families and friends in their battle with the condition.

Dementia is far more than just ‘losing your marbles’. It is a wide range of symptoms linked to deterioration in brain function, caused by diseases of the brain. It not only affects memory, but language, perception of the world around them, reaction times and judgement. A black mat on the floor may appear to a dementia sufferer as a gaping hole, or a shiny surface may be perceived as wet. Many aspects of life become more difficult, including decision making, socialising, and thinking of the right words to use in conversation. (1) People with dementia may become more isolated in turn, either avoiding social situations or losing the company of friends and family who now struggle to know how to act around them.

The causes and symptoms can vary depending on the type of dementia.

Alzheimer’s Disease

This is the most common form of dementia. It is caused by ‘plaques’ of protein and ‘tangles’ of fibres forming in and around brain cells. This results in damage to the nerve cells which relay signals in and out of the brain, and also brain shrinkage. (2) One of the earliest symptoms is short term memory loss – the affected person may struggle to remember the name of someone they have recently met, or ask the same question over and over again. As more areas of the brain become damaged, more symptoms will appear, such as a reduction in organisational skills, confusion, reduced ability to problem solve and mood changes. (3)

Vascular dementia

Vascular dementia occurs when the blood supply to the brain is compromised, which leads to damage and death of brain cells. This can be a result of a stroke or ‘mini’ strokes, or blood vessels within the brain becoming narrowed or blocked. Symptoms include sluggish thoughts, waning concentration, disorientation and balance problems. (4)

Dementia with Lewy bodies

This form of dementia is caused by proteins accumulating inside brain cells and forming deposits known as Lewy bodies. It is believed that these deposits disrupt normal signalling between brain cells, leading to difficulties with movement and processing visual information, sleep disturbances, and alternating periods of alertness and confusion. (5)

Frontotemporal dementia

A less common type of dementia, frontotemporal dementia develops when protein deposits form specifically in the front and side sections of the brain (frontal and temporal lobes). These areas are responsible for the regulation of behaviour, speech and organisation. Therefore, associated symptoms include behavioural changes – selfishness and lack of empathy, impulsiveness and reduced motivation; slow and disordered speech, and reduced planning abilities. (6)

Treatment and management of dementia

Unfortunately, in most cases, dementia will only get worse as time goes on. That’s why it is essential to get a diagnosis as early on as possible and embark on the treatment that is available for some types of dementia, which should help to slow the progression of the condition.

• Acetylcholinesterase inhibitors include donepezil, galantamine and rivastigmine andare used for mild to moderate Alzheimer’s Disease and dementia with Lewy bodies. They work by stopping the breakdown of a chemical released by nerve cells called acetylcholine, which helps the cells to communicate. These medicines may cause heart problems, so ideally patients should be monitored via electrocardiogram (ECG). (7)

• Memantine is given in severe Alzheimer’s Disease, or when acetylcholinesterase inhibitors are unsuitable or ineffective. It works by blocking glutamate, a chemical that is released in large amounts in Alzheimer’s Disease sufferers and worsens the damage to the brain. (8)

• Antidepressants can be used in dementia patients suffering with depression, which is often linked to their struggle with dementia.

• Antipsychotics can be issued when aggression and other behavioural problems associated with dementia may pose a threat to patients themselves or others. However, the risks versus benefits should be thoroughly considered, as these medicines may aggravate the remaining dementia symptoms.

• Psychological treatments may help to ease symptoms of dementia, but will not prevent symptoms from getting worse. They comprise cognitive stimulation therapy and reality orientation therapy which are designed to help memory and state of mind, validation therapy which may help sufferers to be less affected by perceived irrational thoughts, and behavioural therapy, designed to help with problems such as aggression and depression. (7)

Helping people with dementia

As dementia progresses, sufferers will likely become more and more dependent on family, friends and other caregivers to look after them. Still, there are numerous ways in which you can help someone with dementia keep their mind active and experience pleasure in their day to day life.

Focus on helping the person to enjoy themselves. If they have a hobby it can be very helpful for them to continue with this to keep their mind active, as long as their condition allows. There might be a certain song or photograph that helps them to revisit and talk about happy memories from younger days, as long-term memory is usually much less affected than short-term.

Assist the person where possible with everyday tasks they now find more difficult, but be careful not to completely take over unless they want you to, as this may reduce their sense of self-worth. Also, do not be critical as this will probably discourage them from independent task handling in future.

Some people with dementia may find that taking part in creative activities or joining social groups really helps them to feel accomplished and improve their quality of life.

This information is not exhaustive and much more support and guidance can be found online. Visit www.dementiauk.org or take six easy steps to become a Dementia Friend at www.dementiafriends.org.uk/register-digital-friend.

References

1. National Health Service. About dementia [cited 6 September 2017]. Available from: http://www.nhs.uk/Conditions/dementia-guide/Pages/about-dementia.aspx

2. National Health Service. Alzheimer’s disease – Causes [cited 6 September 2017]. Available from: http://www.nhs.uk/Conditions/Alzheimers-disease/Pages/Causes.aspx

3. National Health Service. Symptoms of dementia [cited 6 September 2017]. Available from: http://www.nhs.uk/Conditions/dementia-guide/Pages/symptoms-of-dementia.aspx#alz

4. National Health Service. Vascular dementia [cited 6 September 2017]. Available from: http://www.nhs.uk/Conditions/vascular-dementia/Pages/Introduction.aspx

5. National Health Service. Dementia with Lewy bodies [cited 6 September 2017]. Available from: http://www.nhs.uk/Conditions/dementia-with-lewy-bodies/Pages/Introduction.aspx#causes

6. National Health Service. Frontotemporal dementia [cited 6 September 2017]. Available from: http://www.nhs.uk/Conditions/frontotemporal-dementia/Pages/Introduction.aspx#treatment

7. National Health Service. How is dementia treated? [cited 6 September 2017]. Available from: http://www.nhs.uk/Conditions/dementia-guide/Pages/dementia-treatment.aspx

8. Alzheimer’s Society. Drug treatments for Alzheimer’s disease [cited 6 September 2017].  Available from: alzheimers.org.uk

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 14/09/17